Is ADHD Underdiagnosed When Substance Use is Present?

PostedOctober 9, 2025

UpdatedOctober 9, 2025

ByMy Patient Advice

Author: Avery Lombardi, MSc | Reviewed by: Dr. Rebecca Fernandez, MBBS

Yes, substance use vs. ADHD underdiagnosis is a significant issue. Many individuals with ADHD struggle with addiction or self-medication as they attempt to cope with the symptoms of their undiagnosed condition. The relationship between ADHD and substance use is complex, as people with ADHD may turn to alcohol, drugs, or other substances to manage feelings of restlessness, anxiety, or low mood. However, these substances often mask or exacerbate ADHD symptoms, leading to a misdiagnosis or a failure to recognise the underlying condition.

When substance use is present, ADHD can be harder to identify, as the symptoms of impulsivity, inattention, or hyperactivity may be wrongly attributed to the effects of drugs or alcohol. This makes it more likely that individuals are diagnosed with addiction or other mental health conditions rather than ADHD, leading to a delay in proper treatment.

Why ADHD and Substance Use Can Overlap

Here’s why substance use vs. ADHD underdiagnosis can overlap:

Self-medication

People with ADHD may use substances to quiet their minds, reduce anxiety, or boost focus, which masks the true nature of their ADHD symptoms.

Dual diagnosis

When both ADHD and addiction are present, the symptoms of one condition can cloud the diagnosis of the other, making treatment more complex.

Stigma and misunderstanding

Substance abuse can overshadow the need for ADHD treatment, leading to more emphasis on addiction rather than addressing the underlying neurodevelopmental condition.

In conclusion, a dual diagnosis approach, which recognises both ADHD and substance use, is crucial for proper treatment. Proper identification of both ADHD and substance use is essential for effective, holistic treatment.

Visit providers like ADHD Certify for personal consultations and expert guidance tailored to your unique situation.

For a deeper dive into the science, diagnosis, and full treatment landscape, read our complete guide to Overdiagnosis vs. Underdiagnosis in ADHD.

Avery Lombardi, MSc

Author

Avery Lombardi is a clinical psychologist with a Master’s in Clinical Psychology and a Bachelor’s in Psychology. She has professional experience in psychological assessment, evidence-based therapy, and research, working with both child and adult populations. Avery has provided clinical services in hospital, educational, and community settings, delivering interventions such as CBT, DBT, and tailored treatment plans for conditions including anxiety, depression, and developmental disorders. She has also contributed to research on self-stigma, self-esteem, and medication adherence in psychotic patients, and has created educational content on ADHD, treatment options, and daily coping strategies.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the author's privacy.

Dr. Rebecca Fernandez, MBBS

Reviewer

Dr. Rebecca Fernandez is a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, gynecology, intensive care, and emergency medicine. She has managed critically ill patients, stabilised acute trauma cases, and provided comprehensive inpatient and outpatient care. In psychiatry, Dr. Fernandez has worked with psychotic, mood, anxiety, and substance use disorders, applying evidence-based approaches such as CBT, ACT, and mindfulness-based therapies. Her skills span patient assessment, treatment planning, and the integration of digital health solutions to support mental well-being.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the reviewer's privacy.